Scoliosis is a common spine condition often found in adolescents. Roughly 3 million new cases of the condition are diagnosed in the United States each year, with a majority of them identified as idiopathic scoliosis — a type of scoliosis that presents in children between 10 to 12 years old.
Below, Paul Sponseller, M.D., pediatric orthopaedic expert and director of the Johns Hopkins Division of Pediatric Orthopaedic Surgery, provides five facts about scoliosis that all parents should know before their child’s next physical.
-
It’s important for parents to make sure their children are receiving regular checkups so that conditions like scoliosis can be diagnosed and managed early. “If scoliosis can be diagnosed before the child has a growth spurt,” says Sponseller, “the provider can determine a treatment plan that prevents a bigger curve from forming during times of growth.”
Common signs of scoliosis include uneven shoulders or hips, but it is generally, a painless condition that may go unnoticed until a routine exam or physical. “Children around the age of 10 to 12 are usually becoming more private,” Sponseller notes, “and parents are no longer involved in activities like bathing or dressing them, when they may have otherwise noticed a change.”
-
Parents: It’s not your fault if your child is diagnosed with scoliosis. “Parents tend to ask what they could have done to prevent scoliosis,” says Sponseller, “but scoliosis is a very interesting disease because there is currently no known cause or prevention method.”
It’s also very common for parents to ask if bad posture or heavy backpacks could have caused their child’s scoliosis. While these two things may be associated with other spine and back conditions, they do not cause scoliosis, Sponseller says.
-
“When parents hear scoliosis runs in families, they often say, ‘But nobody in our family has it,’” says Sponseller. “But in reality, it’s likely that someone does or did and it went unnoticed because it was a very mild case.” Of course, there are also instances where a child is the first in the family to develop the condition.
-
“I see a number of patients who automatically assume they will need treatment for their scoliosis, but only a small percentage — about 30 percent — require bracing, and an even smaller percent — about 10 percent — of patients actually require surgery,” Sponseller assures.
If your child is diagnosed with scoliosis, Sponseller says not to be scared. “Scoliosis is a very manageable condition when diagnosed early.” For children who are still growing, an external torso brace can be used to prevent further worsening of scoliosis while the child grows. Even when wearing a brace, most children live normal lives and participate in the same activities as their peers.
-
If your child turns out to be among them, Sponseller — who performs over 150 spine surgeries a year — advises parents that while it may be a hard decision to make on behalf of your child, having surgery sooner rather than later is better. When done early, the surgery tends to be simpler, as less of the spine needs to be fused. Perhaps more importantly, he says, is your child being in good overall health and having the support of his or her family during recovery. Parents should also work with their child’s school to determine a plan for the time the child will miss during recovery — usually one to two months.
Nicholas was diagnosed with scoliosis at age 3, and by 14, despite bracing, his curve had worsened and required surgery. He and his parents planned the procedure at Johns Hopkins with pediatric orthopaedic surgeon Paul Sponseller, but then the pandemic struck. The family knew that a delay in treatment may allow scoliosis to progress, so they were back as soon as surgeries resumed at Johns Hopkins, reassured by the care team about safety protocols. Several weeks later, Nicholas was home, healthy and practicing his golf swing.
1. Morrissy RT, Weinstein SL. Lovell and Winter’s Pediatric Orthopaedics. Philadelphia: Lippincott Williams & Wilkins; 2006. pp. 693–762. [Google Scholar]
2. Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8. [PubMed] [Google Scholar]
3. Mehta MH. Pain provoked scoliosis. Observation on the evolution of the deformity. Clin Orthop Relat Res. 1978;135:58–65. [PubMed] [Google Scholar]
4. Baker AS, Dove J. Progressive scoliosis as the presenting sign of syringomyelia. Report of a case. J Bone Joint Surg Br. 1983;65:472–3. [PubMed] [Google Scholar]
5. Citron N, Edgar MA, Sheehy J, Thomas DG. Intramedullary spinal cord tumours presenting as scoliosis. J Bone Joint Surg Br. 1984;66:513–7. [PubMed] [Google Scholar]
6. Little DG, Song KM, Katz D, Herring JA. Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls. J Bone Joint Surg Am. 2000;82:685–93. [PubMed] [Google Scholar]
7. Wynn-Davies R. Familial (idiopathic) scoliosis. A family survey. J Bone Joint Surg Br. 1968;50:24–30. [PubMed] [Google Scholar]
8. Adams W. London: Churchill Livingston; 1865. Lectures on Pathology and Treatment of Lateral and Other Forms of Curvature of the Spine. [PMC free article] [PubMed] [Google Scholar]
9. Grossman TW, Mazur JM, Cummings RJ. An evaluation of the Adams forward bend test and the scoliometer in a scoliosis school screening setting. J Pediatric Orthop. 1995;15:535–8. [PubMed] [Google Scholar]
10. Gupta P, Lenke LG, Bridwell KH. Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity. Is a magnetic resonance image screening necessary? Spine. 1998;23:206–10. [PubMed] [Google Scholar]
11. Schwend RM, Hennrikus W, Hall JE, Emans JB. Childhood scoliosis: Clinical indications for magnetic resonance imaging. J Bone Joint Surg Am. 1995;77:46–53. [PubMed] [Google Scholar]
12. Barnewolt CE, Estroff JA. Sonography of the fetal central nervous system. Neuroimaging Clin N Am. 2004;14:255–71. [PubMed] [Google Scholar]
13. Basu PS, Elsebaie H, Noordeen MH. Congenital spinal deformity: A comprehensive assessment at presentation. Spine. 2002;27:2255–9. [PubMed] [Google Scholar]
14. Beals RK, Robbins JR, Rolfe B. Anomalies associated with vertebral malformations. Spine. 1993;18:1329–32. [PubMed] [Google Scholar]
15. Kane WJ, Moe JH. A scoliosis-prevalence survey in Minnesota. Clin Orthop Relat Res. 1970;69:216–8. [PubMed] [Google Scholar]
16. Stirling AJ, Howel D, Millner PA, Sadiq S, Sharples D, Dickson RA. Late-onset idiopathic scoliosis in children six to fourteen years old: A cross-sectional prevalence study. J Bone Joint Surg Am. 1996;78:1330–6. [PubMed] [Google Scholar]
17. Rogala EJ, Drummond DS, Gurr J. Scoliosis: Incidence and natural history. A prospective epidemiological study. J Bone Joint Surg Am. 1978;60:173–6. [PubMed] [Google Scholar]
18. Montgomery F, Willner S. The natural history of idiopathic scoliosis: Incidence of treatment in 15 cohorts of children born between 1963 and 1977. Spine. 1997;22:772–4. [PubMed] [Google Scholar]
19. Kane WJ. Scoliosis prevalence: A call for a statement of terms. Clin Orthop Relat Res. 1977;126:43–6. [PubMed] [Google Scholar]
20. Bunnell WP. The natural history of idiopathic scoliosis before skeletal maturity. Spine. 1986;11:773–6. [PubMed] [Google Scholar]
21. Risenborough EJ, Wynne-Davies R. A genetic survey of idiopathic scoliosis in Boston, Massachusetts. J Bone Joint Surg Am. 1973;55:974–82. [PubMed] [Google Scholar]
22. Lloyd-Roberts GC, Pilcher MF. Structural idiopathic scoliosis in infancy. J Bone Joint Surg Br. 1965;47:520–3. [PubMed] [Google Scholar]
23. Tolo VT, Gillespie R. The characteristics of juvenile scoliosis and results of its treatment. J Bone Joint Surg Br. 1978;60-B:181–8. [PubMed] [Google Scholar]
24. King HA, Moe JH, Bradford DS, Winter RB. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am 2001. 1983;65-A:1302–13. [PubMed] [Google Scholar]
25. Lenke LG, Betz RR, Harms J. Adolescent idiopathic scoliosis: A new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 83-A:1169–81. [PubMed] [Google Scholar]
26. Loncar-Dusek M, Pecina M, Prebeg Z. A longitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis. Clin Orthop Relat Res. 1991;270:278–82. [PubMed] [Google Scholar]
27. Peterson LE, Nachemson AL. Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am. 1995;77:823–7. [PubMed] [Google Scholar]
28. Nachemson A, Lonstein JE, Weinstein SL. Park Ridge: Natural History Committee of Scoliosis Research Society; 1982. Report of the prevalence and natural history committee. [Google Scholar]
29. Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am. 1983;65:447–55. [PubMed] [Google Scholar]
30. Weinstein SL. Idiopathic scoliosis. Natural history. Spine. 1986;11:780–3. [PubMed] [Google Scholar]
31. Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: Long term follow-up and prognosis in untreated patients. J Bone Joint Surg Am. 1981;63:702–12. [PubMed] [Google Scholar]
32. Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine. 1992;17:1091–6. [PubMed] [Google Scholar]
33. Pehrsson K, Bake B, Larsson S, Nachemson A. Lung function in adult idiopathic scoliosis: A 20 year follow up. Thorax. 1991;46:474–8. [PMC free article] [PubMed] [Google Scholar]
34. Mayo NE, Goldberg MS, Poitras B, Scott S, Hanley J. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part III: Back pain. Spine. 1994;19:1573–81. [PubMed] [Google Scholar]
35. Payne WK, III, Ogilvie JW, Resnick MD, Kane RL, Transfeldt EE, Blum RW. Does scoliosis have a psychological impact and does gender make a difference? Spine. 1997;22:1380–4. [PubMed] [Google Scholar]
36. Yawn BP, Yawn RA, Hodge D, et al. A population based study of school scoliosis screening. JAMA. 1999;282:1427–32. [PubMed] [Google Scholar]
37. Scoliosis Research Society. Park Ridge: Scoliosis Research Society; 1986. A handbook for patients. [Google Scholar]
38. American Academy of Pediatrics. Elk Grove Village: American Academy of Pediatrics; 1988. Guidelines for health supervision II. [Google Scholar]
39. US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd edn. Washington DC: Office of Disease Prevention and Health Promotion; 1996. [Google Scholar]
40. Canadian Task Force on Periodic Health Examination. Canadian guide to clinical preventive care. Ottawa: Canada Communication Group; 1994. pp. 346–54. [Google Scholar]
41. Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am. 1995;77:815–22. [PubMed] [Google Scholar]
42. Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:664–74. [PubMed] [Google Scholar]
43. Willers U, Normelli H, Aaro S, Svensson O, Hedlund R. Long-term results of Boston brace treatment on vertebral rotation in idiopathic scoliosis. Spine. 1993;18:432–5. [PubMed] [Google Scholar]
44. Dickson JH, Mirkovic S, et al. Results of operative treatment of idiopathic scoliosis in adults. J Bone Joint Surg Am. 1995;77:513–23. [PubMed] [Google Scholar]
Page 2
Patient history components
| Age at onset |
| Evidence of maturation |
| Presence of back pain |
| Neurological symptoms, including gait abnormalities, weakness or sensory |
| changes |
| Feelings about overall appearance and back shape |
| Family history |